SLR - January 2011 - Priya Parthasarathy
Reference: Willits, K. Amendola, A. Bryant, D. Mohtadi,N. Giffin, J.Fowler, P. Kean, C. Kirkley, A. Mohtadi, N. Giffin, R. Fowler, P. (2010). Operative versus Nonoperative Treatment of Acute Achilles Tendon Ruptures : A Multicenter Randomized Trial Using Accelerated Functional Rehabilitation. Journal of Bone and Joint Surgery, 92, 2767-2775.
Scientific Literature Review
Reviewed by: Priya Parthasarathy, DPM
Residency Program: Botsford Hospital
Podiatric Relevance:
Rupture of the Achilles tendon is one of the most common adult tendon injuries in adults and is very often seen in podiatric practices.
Methods:
Patients were randomized into two groups: operative and non-operative treatment for acute Achilles tendon rupture. All patients went through an accelerated rehabilitation protocol which included early weight bearing and range of motion. The primary outcome of this investigation was the rerupture rate which was determined by a positive Thompson squeeze test, the presence of a palpable gap and loss of plantar flexion.
Results:
Seventy-two patients were treated operatively and seventy-two were treated non-operatively. There were 118 males 26 females, and the mean age was 40.4 years. Re-rupture occurred in two patients in the operative group and in three patients in the non-operative group. There was no clinically important difference between groups with regard to strength, range of motion, calf circumference, or Leppilahti score. There were thirteen complications in the operative group and six in the no-noperative group, with the main difference being the greater number of soft-tissue related complications in the operative group.
Conclusions:
The information obtained from this study supports accelerated functional rehabilitation and non-operative treatment for acute Achilles tendon ruptures. All measured outcomes of non-operative treatment were acceptable and were clinically similar to those for operative treatment.